POS0772 HEPATIC STEATOSIS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: PREVALENCE AND ASSOCIATION WITH DISEASE FEATURES
Authors: A. Barrera-Vargas, A. A. Baeza-Zapata, A. Fortanell-Meza, D. San Agustín-Morales, J. Merayo-Chalico, C. Moctezuma-Velázquez
Journal: Annals of the Rheumatic Diseases (2022)

Background The spectrum of hepatic involvement in patients with systemic lupus erythematosus (SLE) is broad and multifactorial. Steatosis is a common finding in liver biopsies performed on these patients; however, there is no further evidence of its prevalence in this population. Early detection of steatosis is important to consider ideal management options, and transient elastography (Fibroscan) offers a non-invasive, fast, and easy tool that provides reliable diagnoses. Objectives To determine the prevalence of hepatic steatosis in patients with SLE by using the controlled attenuation parameter (CAP). We also aimed to describe factors associated with steatosis in lupus, such as metabolic syndrome criteria, treatment, and disease activity. Methods Between July and December 2021, we measured the degree of hepatic steatosis in patients who fulfilled the 2019 EULAR/ACR SLE classification criteria from a rheumatology outpatient clinic in a tertiary referral center in Mexico City, using the CAP obtained with Fibroscan. The cut-off value for considering hepatic steatosis was 275 dB/m. Fibroscan results, metabolic syndrome criteria, treatment, and SLE-associated variables were recorded. Variables were analyzed using Chi-squared, Fisher’s exact, and Mann-Whitney U tests. We used logistic regression to compare variables associated with lupus activity and steatosis. A p value &lt;0.05 was considered statistically significant. Results A total of 102 patients (83% female, mean age 39±14 years) with SLE were included. We identified 23 patients (22.5%) with hepatic steatosis. Patients with steatosis had a higher mean waist-to-hip ratio (WHR; 0.92 vs 0.85 cm p&lt;0.001), and prevalence of overweight/obesity (82% vs 49% p=0.004) compared with patients without steatosis. Univariate analyses showed that steatosis was significantly associated with higher body mass index (BMI; OR 1.24 [95%CI 1.11-1.39], p&lt;0.001), WHR (OR 1.13 [95%CI 1.03-1.23], p=0.006), serum glucose (OR 1.04, [95%CI 1.00-1.07], p=0.04), and paradoxically, higher C3 complement levels (OR 1.03 [95%CI 1.01-1.05], p=0.002). Additionally, hydroxychloroquine was found to be a protective factor (OR 0.34 [95%CI 0.12-0.98], p=0.047). There were no differences between patients with and without steatosis in terms of disease duration and types of activity. Also, no differences were found in the activity (SLEDAI-2K) and chronic damage (SLICC-DI) indices between groups. In the multivariate analysis, the only variables that remained significantly associated with steatosis were BMI (OR=1.23 [95%CI 1.05-1.43], p=0.007), and WHR (OR 1.15 [95%CI 1.03-1.28], p=0.01). Although it did not reach statistical significance, current use of hydroxychloroquine tended to be a protective factor for steatosis (OR=0.18 [95%CI 0.03-1.10], p=0.06). Conclusion The prevalence of hepatic steatosis in patients with SLE is similar to that of the general population. Metabolic risk factors were associated with a higher prevalence of steatosis in patients with lupus, contrary to other SLE disease features such as activity, treatment, and chronic damage. Interestingly, hydroxychloroquine use tended to be a protective factor for steatosis in these patients. Table 1. Characteristics of SLE patients according to the presence of steatosis. All patients Patients without steatosis Patients with steatosis P value (n=102) (n=79) (n=23) Age 37 (29-51) 38 (29-51) 34 (30-55) 0.8 Weight (kg) 66.5 (58-76.7) 63 (57-73) 77 (68-89) &lt;0.001 Body mass index (kg/m 2 ) 26.3 (22.9-29.9) 25 (22-29) 31 (26-33) &lt;0.001 Obesity 25 (24%) 13 (16%) 12 (52%) &lt;0.001 Waist-to-hip ratio 87.2 (81.3-92.2) 85.6 (80.2- 91.7) 92.2 (87.4-94.6) 0.003 Current use of hydroxychloroquine 85 (80%) 70 (84%) 15 (65%) 0.04 SLEDAI score 4 (2-6) 4 (2-6) 2 (1-6) 0.4 SLICC-DI score 1 (0-1) 1 (0-1) 1 (0-1) 0.8 Glucose (mg/dl) 84 (79-92) 83.5 (78-90) 88 (82-93) 0.03 C3 102 (81-124) 99 (78-121) 123 (100-137) 0.003 C4 17 (12-25) 16 (12-25) 20 (14-25) 0.3 Disclosure of Interests Ana Barrera-Vargas Paid instructor for: Sanofi, Consultant of: Astra Zeneca and Sanofi, Armando Antonio Baeza-Zapata: None declared, André Fortanell-Meza: None declared, Diego San Agustín-Morales: None declared, Javier Merayo-Chalico Speakers bureau: Pfizer and Janssen, Paid instructor for: Sanofi, Consultant of: Janssen, Carlos Moctezuma-Velázquez Consultant of: Roche and Eisai